Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2013
Randomized Controlled TrialThe effect of cisatracurium and rocuronium on lung function in anesthetized children.
Neuromuscular blocking drugs have been implicated in intraoperative bronchoconstrictive episodes. We examined the effects of clinically relevant doses of cisatracurium and rocuronium on the lung mechanics of pediatric subjects. We hypothesized that cisatracurium and rocuronium would have bronchoconstrictive effects. ⋯ At clinically relevant doses, both cisatracurium and rocuronium caused changes in lung function, indicating constriction of smaller airways. In general, these changes were mild and not clinically detectable. However, in the rocuronium group, 3 of 13 patients showed more noticeable decreases in MEF10 (≤50%), demonstrating the potential for significant broncho-bronchiolar constriction in susceptible patients.
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Anesthesia and analgesia · Dec 2013
Randomized Controlled Trial Comparative StudyThe effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children.
Pudendal nerve block provides better analgesia in the first 24 hours for children following hypospadias repair than does caudal block.
pearl -
Anesthesia and analgesia · Dec 2013
Randomized Controlled TrialContinuous interscalene block in patients having outpatient rotator cuff repair surgery: a prospective randomized trial.
Continuous interscalene block offers analgesic benefits up to 1 week after shoulder surgery when compared with either single-shot block or GA alone.
pearl -
Anesthesia and analgesia · Dec 2013
ReviewPredicting fluid responsiveness in children: a systematic review.
Administration of fluid to improve cardiac output is the mainstay of hemodynamic resuscitation. Not all patients respond to fluid therapy, and excessive fluid administration is harmful. Predicting fluid responsiveness can be challenging, particularly in children. Numerous hemodynamic variables have been proposed as predictors of fluid responsiveness. Dynamic variables based on the heart-lung interaction appear to be excellent predictors of fluid responsiveness in adults, but there is no consensus on their usefulness in children. ⋯ Respiratory variation in aortic blood flow peak velocity was the only variable shown to predict fluid responsiveness in children. Static variables did not predict fluid responsiveness in children, which was consistent with evidence in adults. Dynamic variables based on arterial blood pressure did not predict fluid responsiveness in children, but the evidence for dynamic variables based on plethysmography was inconclusive.
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Anesthesia and analgesia · Dec 2013
Apparent Dead Space with the Anesthetic Conserving Device, AnaConDa®: A Clinical and Laboratory Investigation.
The anesthetic conserving device (ACD) reduces consumption of volatile anesthetic drug by a conserving medium adsorbing exhaled drug during expiration and releasing it during inspiration. Elevated arterial CO2 tension (PaCO2) has been observed in patients using the ACD, despite tidal volume increase to compensate for larger apparatus dead space. In a test lung using room temperature dry gas, this was shown to be due to adsorption of CO2 in the ACD during expiration and release of CO2 during the following inspiration. The effect in the test lung was higher than in patients. We tested the hypothesis that a lesser dead space effect in patients is due to higher temperature and/or moisture attenuating rebreathing of CO2. ⋯ The use of an ACD increases apparent dead space to a greater extent than can be explained by its internal volume. This is caused by adsorption of CO2 in the ACD during expiration and release of CO2 during inspiration. Rebreathing of CO2 was attenuated by moisture. The dead space effect of the ACD could be clinically relevant in acute respiratory distress syndrome and other diseases associated with ventilation difficulties, but investigations with larger sample sizes would be needed to determine the clinical importance.